Ovarian cancer diagnosis and management (radio and chemo lecture) Flashcards Preview

Y4 Obstetrics and Gynaecology > Ovarian cancer diagnosis and management (radio and chemo lecture) > Flashcards

Flashcards in Ovarian cancer diagnosis and management (radio and chemo lecture) Deck (24)
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1
Q

What are the risk factors for the development of ovarian cancer ?

A
  • >50yrs
  • nulliparity (or low parity)
  • family history of breast or ovarian cancer - BRCA1 (40%) and BRCA2 (18%), lynch syndrome
  • Obesity/diabetes
  • Smoking
  • Endometriosis
2
Q

What are some of the protective factors against ovarian cancer ?

A
  • Combined pill
  • Hysterectomy or tubes tied
  • Pregnancy and breastfeeding
3
Q

What the symptoms of ovarian cancer ?

A
  • Ascites/ bloating - that doesnt come and go
  • Persistent pelvic and abdominal pain
  • Eating less and feeling fuller
  • Pelvic mass/ bladder dysfunction
  • Pleural effusion/shortness of breath
  • Change in bowel habit
  • Bladder symptoms - freq or urge urination
  • Weight loss/anaorexia
4
Q

Roughly what stage do most ovarian cancers present at ?

A

Late stage

5
Q

Screening for ovarian cancer is not recommended but when should a women be referred for a genetics risk assessment +/- testing ?

A

Women with ovarian cancer who have a family history of breast ovarian or colon cancer should have a genetic risk assessment.

6
Q

Who should be offered BRAC1 and BRCA2 testing ?

A

All women with non-mucinous ovarian or fallopian tube cancer should

be offered BRCA1 and BRCA2 mutation testing.

7
Q

Who should be offered Prophylactic salpingo-oophorectomy?

A

Women with genetic mutations of BRCA1 or BRCA2 genes should be

offered prophylactic oophorectomy and removal of fallopian tubes

at a relevant time of their life.

8
Q

When should you carry out investigations for ovarian cancer ?

A

In women presenting with one or more of the following symptoms on a persistent or frequent basis – particularly more than 12 times per month:

  1. Abdominal distension or bloating with or without abdominal pain
  2. Feeling full quickly
  3. Difficulty eating
  4. Increased urinary urgency or frequency
9
Q

What are the 2 first investigations you should carry out for someone with histroy suggestive of ovarian cancer (previously mentioned guidelines for when to investigate)

A

1st line = blood test to check CA125 levels along with an abdominal or transvaginal US

10
Q

What should you do if a womens symptoms persist or worsen despite normal CA 125 and a negative ultrasound scan?

A

Refer to secondary care.

11
Q

What should you measure in women <40 with suspected ovarian cancer and why?

A

AFP and beta HCG

To identify women who may not have epithelial ovarian cancer.

12
Q

What are some of the other reasons for raised CA125?

A

Raised in ≈80% ovarian cancers but Normal level does not exclude cancer

Moderate elevation seen in numerous situations e.g.

  • Endometriosis
  • Peritonitis/infection
  • pregnancy
  • Pancreatitis
  • Ascites from any cause.e.g. liver disease
  • Other malignancies gynae/non gynae.
13
Q

After results of CA125 and US suggesting ovarian cancer what should be calculated ?

A

Risk of malignancy index 1(RMI 1) score

14
Q

Appreicate this (refer to pic 19 of ovarian cancer lecture if needed) but these are the take home points:

  • Bascially if postmenopausal they have a higher number for calculation
  • If they have more suspicious features on US then a higher number is put in for that bit of the calculation
  • The higher the CA125 the higher the RMI 1
A
15
Q

How is someones RMI 1 calculated and what is the level which would be raised indicating malignancy ?

A

RMI 1 >200

16
Q

What are the US features which as suggestive of ovarian cancer ?

A
  • Complex mass with solid & cystic area.
  • Multi-loculated
  • Thick septations
  • Associated ascites
  • Bilateral disease.
17
Q

What should be done next after calculating someones RMI 1 score in someone suspected of having ovarian cancer and finding it is >200?

A

Send for CT of abdo and pelvis

18
Q

After doing CT what is the last investigation which needs to be done to obtain the definite diagnosis of ovarian cancer and the type of it?

A

CT guided biopsy for histological study

19
Q

What is the FIGO staging for ovarian cancer ?

A

FIGO stage:-

  • I- confined to 1 or both ovaries
  • II-spread to other pelvic organs eg uterus, fallopian tubes
  • III- spread beyond the pelvis within the abdomen
  • IV- spread into other organs eg liver, lungs
20
Q

What are the 2 main ways in which ovarian cancer spreads?

A
  • 1.transcoelomic spread/ peritoneal seeding within pelvis → abdominal cavity
  • 2.haematogenous spread → liver, lungs, brain- late and rare
21
Q

Define early ovarian cancer and late/advanced ovarian cancer ?

A

Early = stage Ia to Ib (confined to the ovaries)

Late = stage Ic to IV

22
Q

What should be done for optimal surgical staging of early stage ovarian cancer (done during the main surgical treatment procdure) ?

A

Optimal surgical staging should be done and should include:

  • Biopsies of suspicious looking peritoneal nodules
  • Infracolic omentectomy
  • Iliac and peri-aortic lymph node sampling (retro-peritoneal lymph node sampling)”

Note retro-peritoneal lymph node sampling rather than systematic lymphadectomy (block dissection of lymph nodes from the pelvic side walls to the level of the renal veins) is recommended

23
Q

What is the surgical management of early ovarian cancer ?

A

Women with stage Ia, grade 1 or grade 2 disease, fertility conserving surgery is an option as long as the contralateral ovary appears normal and there is no evidence of omental or peritoneal disease - this procedure is a unilateral Salpingo-oophorectomy

Women with stage Ib or grade 3 will undergo a total abdominal hysterectomy (TAH) and bilateral salpingo-oophorectomy (BSO). (removal of both ovaries uterine tubes and uterus + cervix)

24
Q

When is adjuvant chemotherapy adviced for early stage (I) ovarian cancer ?

A

Do not offer adjuvant chemotherapy to women who have had optimal surgical staging and have low-risk stage I disease which is - (grade 1 or 2, stage Ia or Ib).

Offer women with high-risk stage I disease (grade 3 Ia or Ib or stage Ic) adjuvant chemotherapy consisting of six cycles of carboplatin.

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